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我們的公眾號(hào)也迎來了自己的小程序了喲 歡迎大家掃描添加,，更有不一樣的內(nèi)容等著大家喲
CT可確定平片無法顯示的肺部病變,、發(fā)現(xiàn)隱蔽的空洞,，特別是隱匿于胸腔積液中的空洞、發(fā)現(xiàn)支氣管狹窄及支氣管阻塞和息肉狀的,、充填于支氣管內(nèi)的引起肺不張的支氣管結(jié)核,。CT在原發(fā)性肺結(jié)核的診斷中發(fā)揮著重要的作用，對(duì)于肺門和縱隔淋巴結(jié)的增大也易于發(fā)現(xiàn),。CT對(duì)早期的粟粒樣陰影顯示優(yōu)于普通平片,，因此當(dāng)疑為粟粒性肺結(jié)核時(shí)應(yīng)對(duì)進(jìn)行胸部CT檢查。在肺外結(jié)核病方面,，包括結(jié)核性腦膜炎,、淋巴結(jié)結(jié)核、支氣管結(jié)核,、結(jié)核性漿膜炎,、骨關(guān)節(jié)結(jié)核等也有重要的輔助診斷價(jià)值。 CT can determine pulmonary lesions that cannot be shown by plain films, detect hidden voids, especially voids hidden in pleural effusion, detect bronchial stenosis and bronchial obstruction and polypoid bronchial tuberculosis causing atelectasis in the bronchus. CT plays an important role in the diagnosis of primary tuberculosis, and it is also easy to detect the enlargement of hilar and mediastinal lymph nodes. CT is superior to plain film in showing early miliary shadow, so chest CT examination should be carried out when suspected miliary tuberculosis. In the aspect of extrapulmonary tuberculosis, including tuberculous meningitis, lymph node tuberculosis, bronchial tuberculosis, tuberculous serositis, osteoarthrosis tuberculosis also have important auxiliary diagnostic value. （8）：氣道壁增厚與擴(kuò)張 ↑ 氣道壁增厚伴擴(kuò)張：CT示右上葉后段肺結(jié)核病灶伴支氣管壁增厚及管腔擴(kuò)張,。 氣管壁增厚在HRCT上表現(xiàn)為氣道壁的厚度值大于同級(jí)正常氣道,，氣道壁的增厚有時(shí)伴有擴(kuò)張，典型者可呈‘雙軌征’表現(xiàn),。 In HRCT, the thickening of the airway wall shows that the thickness value of the airway wall is greater than that of the normal airway at the same level. The thickening of the airway wall is sometimes accompanied by expansion, and the typical one can present the 'dual-track sign'. ↑ 支氣管壁增厚：CT掃描可見左肺上葉主支氣管結(jié)核,，導(dǎo)致管壁增厚、管腔不規(guī)則狹窄,，遠(yuǎn)端支氣管阻塞伴左上葉肺不張,。 ↑ 支氣管腔狹窄與閉塞：CT示左肺下葉背段結(jié)核病灶，可見支氣管漸進(jìn)性狹窄與閉塞伴肺實(shí)變。 （9）：間質(zhì)性病變 ↑ 肺結(jié)核病灶伴間質(zhì)性改變：CT示雙上肺結(jié)核病灶可見線樣與網(wǎng)織狀陰影,，伴彌漫分布的小結(jié)節(jié)影,，右上肺可見薄壁空洞陰影。 部分肺結(jié)核患者CT表現(xiàn)以間質(zhì)性病變?yōu)橹?，甚至活?dòng)性肺結(jié)核也是如此,。主要包括小葉間隔增厚和小葉內(nèi)間質(zhì)異常，前者多發(fā)生于氣道播散區(qū),，可能余小葉中心結(jié)節(jié)的增大與融合累計(jì)肺小葉結(jié)構(gòu)有關(guān),。經(jīng)過治療后可大部分吸收。而肺結(jié)核小葉間質(zhì)異?？赡芫哂幸欢ǖ奶卣餍?，主要出現(xiàn)于粟粒性肺結(jié)核和少數(shù)繼發(fā)性肺結(jié)核病灶中。 CT findings of some tuberculosis patients are mainly interstitial lesions, even active tuberculosis. Mainly including interlobular septal thickening and interlobular mesenchymal abnormality, the former mostly occurs in the airway spreading area, and the enlargement of central nodules of the residual lobule may be related to the fusion accumulation of lung lobules. Most of it can be absorbed after treatment. The lobular interstitial abnormality of pulmonary tuberculosis may be characteristic, mainly occurring in miliary pulmonary tuberculosis and a few secondary pulmonary tuberculosis. （10）：淋巴結(jié)腫大 ↑ 縱隔淋巴結(jié)腫大：中縱隔內(nèi)可見多發(fā)淋巴結(jié)腫大,，呈薄壁環(huán)形強(qiáng)化,，中央壞死無強(qiáng)化，為淋巴結(jié)結(jié)核,。 胸內(nèi)淋巴結(jié)腫大也是肺結(jié)核常見的征象之一,，主要包括肺門和縱隔淋巴結(jié)腫大，通常以淋巴結(jié)短徑大于1.0cm為增大的標(biāo)準(zhǔn),。腫大的淋巴結(jié)在CT上的表現(xiàn)為淋巴結(jié)均質(zhì)腫大,，中心液性低密度，中心脂肪密度和淋巴結(jié)鈣化等,，后三者多提示為良性結(jié)核病病變,。病理上腫大的淋巴結(jié)外圍部分為肉芽組織的纖維環(huán)，中心部分為融合性干酪樣壞死灶,?；顒?dòng)性淋巴結(jié)結(jié)核CT增強(qiáng)后多表現(xiàn)為周邊環(huán)形強(qiáng)化或花邊狀融合病灶，中央壞死無強(qiáng)化,。 Intrathoracic lymph node enlargement is also one of the common signs of tuberculosis, mainly including pulmonary hilum and mediastinal lymph node enlargement, usually with lymph node short diameter greater than 1.0cm as the standard for enlargement. On CT, the enlarged lymph nodes showed homogeneous enlargement of lymph nodes, low central fluid density, central fat density and lymph node calcification, and the latter three were mostly benign tuberculosis lesions. The peripheral part of the pathological enlarged lymph node is the fibrous ring of granulation tissue, and the central part is the fused caseous necrosis. The enhanced CT scan of the active lymph node usually shows peripheral ring enhancement or lacy fusion, but no enhancement in central necrosis. （11）：胸腔積液 ↑ 左側(cè)大量胸腔積液：CT示左側(cè)結(jié)核性胸膜炎伴大量胸腔積液,，左肺明顯壓縮不張，縱隔向右側(cè)移位,。 ↑ 右側(cè)葉間胸膜包裹性積液：CT示右側(cè)結(jié)核性胸膜炎,，胸腔積液伴葉間胸膜包裹性積液,，呈橢圓形密度影,。 結(jié)核性胸膜炎時(shí)可以出現(xiàn)胸腔積液，有時(shí)可有肺結(jié)核同時(shí)發(fā)生,，胸腔積液在CT上表現(xiàn)為胸腔后部沿胸廓內(nèi)緣走行的星月形液性密度影,，有學(xué)者將液性低密度區(qū)占據(jù)胸腔前后徑的后1/3視為少量積液，中1/3為中量，前1/3為大量積液,。當(dāng)積液進(jìn)入葉間裂并發(fā)胸膜粘連時(shí),，可出現(xiàn)梭形或球形陰影，易與肺內(nèi)病變混淆,，病程較長(zhǎng)的結(jié)核性胸膜炎易發(fā)生胸膜粘連,、增厚及包裹性積液，當(dāng)合并氣胸和支氣管胸膜瘺時(shí),，胸腔內(nèi)可見液氣平面,。 Pleural effusion can occur during tuberculous pleurisy, and sometimes pulmonary tuberculosis can occur simultaneously. Pleural effusion on CT shows a stare-shaped liquid-liquid density shadow along the inner edge of the thoracic cavity at the back of the chest. Some scholars regard the latter 1/3 of the pleural diameter occupied by the low-density liquid area as a small amount of pleural effusion. When the effusion enters the interlobular fissure complicated by pleural adhesion, spindle shape or spherical shadow can appear, which is easily confused with pulmonary lesions. The tuberculous pleurisy with a long course of disease is prone to pleural adhesion, thickening and enveloping effusion. When combined with pneumothorax and bronchial pleural fistula, liquid-gas plane can be seen in the thoracic cavity. |
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